Characteristics and Outcomes of Patients Referred to an Emergency Department-Based End-of-Life Care Service in Hong Kong: A Retrospective Cohort Study.

BACKGROUND: This study describes the characteristics and outcomes of patients referred to an emergency department (ED)-based end-of-life (EOL) service in a tertiary acute hospital in Hong Kong. We examine how emergency physicians (EPs) perform in recognizing and managing dying patients. METHODS: From September 2010 to April 2018, patients referred to this EOL service in this hospital were included. A group of 5 EPs assessed whether the referred patient would die within a few days. Dying patients (EOL group) were admitted to ED-based EOL service whereas those not likely dying within few days (non-EOL group) would continue management in respective specialty wards. Baseline characteristics of these 2 groups were compared. The time-to-death and use of opioids and anticholinergics were compared. RESULTS: In total, 783 of 830 patients assessed were recognized as being in dying phase, with 688 admitted under ED-based EOL care. Their demographics and characteristics were described. Mean time from assessment to death (time-to-death) was significantly less in EOL group (38.93 hours) than in non-EOL group (250.36 hours; P = .004). Mean time-to-death was not significantly different between those under EP-based EOL service or not. The ED-based EOL care had significantly more patients receiving symptomatic treatment. INTERPRETATION: The characteristics of patients under an ED-based EOL service are described. Emergency physicians are capable of recognizing dying patients. Emergency department-based EOL service does not alter the dying process and offers adequate palliation of symptoms. Emergency physician should assume a more active role in providing adequate EOL care to suitable patients.

Feasibility of sonographic access to the cricothyroid membrane in the presence of a rigid neck collar in healthy Chinese adults: A prospective cohort study.

OBJECTIVES: (1) To study the dimensions of cricothyroid membranes (CTMs) in healthy Chinese adults in two neck positions, one with rigid neck collar (RNC) and neck extended by ultrasonography (USG). (2) To evaluate how body habitus and neck positions may affect the access time of CTMs, and thus the feasibility for ultrasound-guided cricothyroidotomy. METHODS: We scanned 39 adult staff of a local emergency department. Their CTMs were measured by two emergency physicians (EP) separately. The subjects' gender, weight, height, age, neck circumferences and BMI were collected. Image qualities (graded in 'inadequate, adequate and good') and image acquisition time of the CTMs were also recorded to ascertain proper CTM measurements. RESULTS: The mean depth of the CTM (neck extended) was 5.6 mm, and the standard deviation (SD) was 1.52. The mean depth (with RNC) was 5.97mm with SD 1.61. The mean length of the CTM (mm ± SD) with the neck extended and with the RNC was 10.5 ± 2.15 and 9.97 ± 2.24, respectively. The median image acquisition time for neck extended was 6.36s with interquartile range (IQR) of 2.32-8.4 s, while for RNC the median time was 5.60 s (IQR = 3.71-7.49; P = 0.539). Image acquisition time between the first and the second sonographers was similar. All subjects' CTM could be identified readily by USG. CONCLUSIONS: The CTM can be located quickly and reliably by bedside USG, even in overweight/obese persons with or without an RNC in place. We recommend that further study on the feasibility of bedside cricothyroidotomy with RNC kept on should be explored.